Mental Health America - Mental Health America Bloghttp://www.nmha.org/newsletter/mental-health-america-blog
Mental Health America Blog - Chiming In
enReforming Obamacare: The Challenge Ahead for Mental Healthhttp://www.nmha.org/blog/reforming-obamacare-challenge-ahead-mental-health
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<p><em>By: Paul Gionfriddo, MHA president and CEO</em></p>
<p>To contain costs, President-Elect Donald Trump has suggested replacing Obamacare with a package of benefits that might include:</p>
<ul><li><span style="font-size:14px;">Permitting Insurance to be sold across state lines</span></li>
<li><span style="font-size:14px;">Retention of the mandate covering pre-existing conditions</span></li>
<li><span style="font-size:14px;">Allowing young people to remain on parents’ insurance</span></li>
<li><span style="font-size:14px;">Creating high-risk pools to provide insurance to people with chronic diseases</span></li>
<li><span style="font-size:14px;">Using Health Savings Accounts (HSAs) as an alternative to tax credits</span></li>
<li><span style="font-size:14px;">Expanding the use of high-deductible plans to lower premium costs</span></li>
</ul><p><span style="font-size:14px;">Several of the provisions could affect people with mental health concerns more than others. Let’s consider some of the challenges the President-Elect and Congress will face as they craft these – and other – possible changes to the Affordable Care Act (ACA). </span></p>
<p><strong>Covering Pre-Existing Conditions</strong></p>
<p>Trump has been clear that he would retain this provision. It is a lifeline for people with all chronic diseases and conditions. However, these conditions are often expensive to cover. Unless you mix them in a plan that captures healthier people, too, costs will rise no matter what else you do.</p>
<p><strong>Allowing Children to Remain on Parents’ Insurance Until Age 26</strong></p>
<p>Trump also favors this. It’s very important to families, because so many serious mental health concerns begin during childhood. Here’s the challenge. What is life-saving for young people with serious health conditions is a provision that also keeps healthy, younger people out of the exchanges.That has helped to drive up the costs of the plans in the exchanges. If you can’t figure out how to get health young people into the exchanges, you make insurance more expensive for everyone else.</p>
<p><strong>Setting Up High-Risk Pools</strong></p>
<p>Trump has also suggested that new high-risk pools could be the answer for people with chronic diseases who need insurance. We had a high-risk pool in Connecticut when I was a state legislator in the 1970s and 1980s. It was expensive, and the only people who chose to be in it were the ones who absolutely knew that the insurance would pay out more than the premiums cost. Unless these risk pools are heavily subsidized and include some incentive for healthier people to join them, they probably won’t work.</p>
<p><strong>Expanding the Use of Health Savings Accounts (HSAs) Coupled with High-Deductible Plans</strong></p>
<p>Trump has suggested coupling HSAs with the use of more high-deductible plans to lower costs. In “exchange speak,” think more bronze plans. Here’s the way this might work. </p>
<p>Assume that a single male with high healthcare costs who makes $50,000 per year buys a plan with a $10,000 deductible and pays $250 per month for the insurance. To use an HSA to cover those costs, he would deposit $13,000 into his HSA to cover the premium and the deductible. That would reduce his taxable income to $37,000. If he is in the 15% tax bracket, at the end of the year he would get back 15% of the $13,000 he deposited into his HSA, or $1,950.</p>
<p>Spending one-quarter of his income on health care to get back $1,950 would not make him feel too good about that high-deductible plan, and he would probably go uninsured.</p>
<p><strong>Rolling Back Medicaid Expansion and Converting Medicaid to a Block Grant</strong></p>
<p>Any debate about ACA change will include at least some discussion about rolling back the Medicaid expansion. This expansion has been a huge benefit to adults with serious mental illnesses.</p>
<p>Most states expanded Medicaid, including Michigan, Pennsylvania, Ohio, Iowa, and Arizona. The federal government is covering more than 90 percent of that cost. Trump has said that he does not want to roll back entitlements. Neither would the voters in these states.</p>
<p>Trump has also suggested converting Medicaid to a block grant.This could be done, because the Medicaid program is in reality fifty different state programs. But the question would boil down to this. Would the federal government provide the full share of Medicaid payments to states in the block grant, or withhold a few percent, as it did with past block grants? Withholding even 5 percent of $550+ billion Medicaid dollars would have an enormous impact on state budgets and people in need.</p>
<p><strong>The Challenge Ahead</strong></p>
<p><span style="font-size:14px;">The goal of ACA was to get more people insured, using the health care financing system that was already in place. </span></p>
<p><span style="font-size:14px;">The challenge ahead will be to keep them insured if ACA is changed. Probably the best way to do this – Medicare for all – won’t happen anytime soon. But if the new President and Congress don’t walk a tightrope in making their changes, single-payer may come along a whole lot sooner than anyone imagines.</span></p>
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Tue, 15 Nov 2016 17:32:12 +0000EWallace1373 at http://www.nmha.orghttp://www.nmha.org/blog/reforming-obamacare-challenge-ahead-mental-health#commentsWe Hear You...http://www.nmha.org/blog/we-hear-you
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<p><em>By: America Paredes, Senior Director of Partnerships and Community Outreach</em></p>
<p>The last 48 hours have been shocking for many, to say the least. Many of you are fearful of what comes next. We understand. We hear you.</p>
<p>In light of the election results, many individuals have reached out to us and shared their concern, anxiety, and despair about the impact that the next four years and beyond may have on the lives of individuals that are part of any community that is deemed as “other.”</p>
<p>We recognize that these feelings are natural reactions, as similar and valid, as feelings that can arise when having experienced a sudden, dramatic change in one’s life. Still, after similar events across our communities, we always seem to stand back up again and work together to move forward.</p>
<p>Our founder, Clifford W. Beers, wrote in 1903 about the need to work together to address the inequities that existed for individuals living with a mental illness and he put forth the need for action by embracing the call to <em>Fight in the Open </em>to create change.</p>
<p>Our work, and that of our affiliates, has and continues to be guided by the efforts began by Clifford Beers and we will continue to work with the current and incoming administration to move the conversation and legislation forward.</p>
<p>For us, nothing changes. We continue to focus on prevention, early identification and intervention, integration of health, behavioral health and other services, with recovery as the goal. We’re all about acting B4Stage4, and we believe that there remain strong majorities in Congress to help achieve that goal.</p>
<p>We realize that the vastness of issues that are present and can be denied in the future, can be quite overwhelming to consider, but we will continue to take them all on, working hard to ensure that early intervention, prevention, and adequate mental health care are available to all.</p>
<p>Today and in the future, we ask that you empathize and support one another, <u>ensuring that those who may feel ostracized or abandoned know that they are not alone</u>. Support is critical in moving forward. The mental health impacts of the current season as well are often substantial and may be overwhelming for some and we ask that you look out for one another. Talk about your feelings and seek help if needed.</p>
<p>Reach out to our <a href="http://www.mentalhealthamerica.net/find-affiliate">local affiliates</a> and get involved in your community. <a href="http://takeaction.mentalhealthamerica.net/site/Donation2?df_id=2421&amp;2421.donation=form1">Support</a> our efforts as we continue to move forward in working across systems to ensure that the mental health of all individuals is addressed adequately and effectively #B4Stage4.</p>
<p>Finally, if you or someone you know needs to talk with someone, they can always reach out to the National Suicide Prevention Lifeline at 1-800-273-8255 or Crisis Text Line by sending the letters MHA via text to 741-741. Both services are free and available 24/7.</p>
<p><img alt="" src="http://www.mentalhealthamerica.net/sites/default/files/Crisis%20Text%20Line%203%20%28002%29.jpg" style="width: 300px; height: 300px;" /></p>
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Thu, 10 Nov 2016 16:57:58 +0000AParedes1371 at http://www.nmha.orghttp://www.nmha.org/blog/we-hear-you#commentsWhat’s REALLY Scary about Mental Healthhttp://www.nmha.org/blog/what%E2%80%99s-really-scary-about-mental-health
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<p><em>By: Kelly Davis, MHA Policy and Programs Associate and Theresa Nguyen, MHA Senior Director of Policy and Programs</em></p>
<p>Every year around Halloween we see a recurring rise of haunted asylums, straight jacket “psycho” costumes, and costumes depicting suicide. At MHA, we’ve called for the removal of offensive costumes and attractions, and to draw attention to why these representations are just wrong. They falsely paint people with mental health conditions as violent and scary. They dishonor countless people who have been harmed by attitudes about mental health - people who survived through living in chains, lobotomies, and forced sterilization, and who were often forgotten and left to die in large state-run hospitals. Some justify their Halloween costumes and activities by saying we do not treat people this way anymore. But what many of these portrayals hide is the real terror and violence experienced by people living with mental health conditions today. These experiences include:</p>
<ul><li>Feeling unheard. It often takes a long time to decide you want to reach out and get treatment. When you finally do, it can feel like people are not listening. Imagine finally sharing something you’ve been deeply struggling with to have people not believe you or dismiss your experiences as a “stage” or an “overreaction”. Imagine asking your provider about serious side effects or a new problem only to have them dismiss and ignore your legitimate concerns. Whether it’s family, friends, or providers, it is scary and lonesome when the people around you do not believe or listen to you.</li>
<li>Losing control. Experiencing a mental health crisis is hard enough. It can have all sorts of effects on your health, relationships, work, education, and life. When entering into an emergency crisis treatment facility, it is scary when you are stripped of your rights to make choices about your life, what you want and need, and how you should be treated.</li>
<li>Experiencing isolation. For people who have chronic mental health problems, living in isolation from society can become an everyday reality. When we lose our ability to connect with others or feel rejected by the people around us, we lose our sense of self and meaning. What’s more, a lack of community-based services often means that people end up out of their homes, away from their communities, and hospitalized, incarcerated, or homeless. For those in hospitals, jails, and prisons, isolation rooms still exist. It is scary to lose major parts of your life and your ability to freely connect with other people.</li>
<li>Being restrained. Physical, mechanical, and chemical restraints are used in hospitals, jails, prisons, and schools. The images you see at Halloween of people in hospitals tied to beds or isolated in rooms are not fantasy. This still happens to adults and kids across the US. People who are experiencing crises and need support experience increased traumatization instead. After these experiences it’s understandable why we’re less likely to trust services in the future. It is scary to be treated like you are less than human and to be tied up, held down, or forcibly sedated.</li>
</ul><p>With the voices of individuals with lived experience, we’ve come a long way in improving the way we conceptualize and support people with mental health conditions. We now know that recovery is possible even if it does not look the same for everyone. Most importantly, we know that the only way to help a person recover is to ensure their dignity and self-determination in the process.</p>
<p>During Halloween, we hope to open a dialogue to show that people with mental health conditions are just people, and that their traumas and the history of abuse have no place as a costume or horror entertainment.</p>
<p>Here’s what “mental patients” really look like!</p>
<p><img alt="" src="http://www.mentalhealthamerica.net/sites/default/files/IMG_0881.jpg" style="width: 350px; height: 263px;" /></p>
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Fri, 28 Oct 2016 15:45:41 +0000EWallace1369 at http://www.nmha.orghttp://www.nmha.org/blog/what%E2%80%99s-really-scary-about-mental-health#commentsS2S: Our Answer to a Call for Helphttp://www.nmha.org/blog/s2s-our-answer-call-help
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<p><em>By: Paul Gionfriddo, president and CEO, Mental Health America</em></p>
<p>From the time Mental Health America launched our online mental health screening program in 2014, we have asked screeners what they want. Their most frequent response? “Help.”</p>
<p>We’ve been thinking a a lot about what screeners need and how we can most effectively provide them help. But what do they mean by “help?” And does the meaning change based on who is answering the question?</p>
<p>As we approach two million screeners, we have a pretty good idea about what tools our help-seeking screeners are looking for. Younger screeners – who are the majority – tell us they want apps. They want to access them from smart phones, and use them as vehicles to get follow-up services and supports. Older screeners, who frequently access our screening via laptop and desktop computers, want hard copy fact sheets. The majority of all screeners, regardless of age, want to be able to use these tools in the comfort of their own homes in order to work through a plan before they reach out for the assistance they need. And pretty much everyone wants interactive resources – they want to get and give feedback as they navigate an often confusing services delivery system.</p>
<p>But there’s more. What we also have now is a pretty good idea of the areas in which people want to use these tools. And that’s what is at the foundation of Mental Health America’s new “S2S” (Screening-to-Supports) program.</p>
<p>This week it was announced that <a href="http://www.riotgames.com/">Riot Games</a> – the makers of the video game League of Legends – selected Mental Health America as one of four charities world-wide to benefit from a major fall 2016 fundraising appeal in partnership with Omaze. Riot Games committed to awarding at least $250,000 to each charity.</p>
<p>For MHA, those dollars will be dedicated to laying the foundation for S2S.</p>
<p>S2S will offer services and supports in four domains:</p>
<ul><li>Information and Education;</li>
<li>Referrals to services and supports;</li>
<li>Do-It-Yourself tools to monitor health and mental health;</li>
<li>Engagement with “people like me” throughout the world to bring more peer support to individuals experiencing mental health concerns.</li>
</ul><p>Just as they’ve asked, people will be able to access these through apps, fact sheets, and interactive materials. </p>
<p>Throughout the next twelve months, MHA will be adding tools and resources to our S2S program in each of these domains. We will also be soliciting feedback from those who use them about which they find most helpful. We will develop some of these tools and resources ourselves, and we will also seek out partnerships with others who want to make their resources available to the millions of our constituents who will access them.</p>
<p>This will be a dynamic exercise. For the first time we will bring into a single environment both early detection resources and the tools people want and need to move quickly down pathways to recovery. This will be challenging, but we’re up to it.</p>
<p>After all, we are living in the 21st century, and virtual environments offer an extraordinary opportunity to reach out to people across huge geographical areas – really, anywhere in the world – and connect them to lives services and supports, and to other people experiencing the same circumstances wherever they happen. S2S is designed to take advantage of this new opportunity by breaking down artificial geographical boundaries, and to help bring much-needed supports to people who have long been isolated from them.</p>
<p>We’ll be sharing much more about S2S in the months to come. </p>
<p>In the meantime, know that our screeners comprise one of the most extensive help-seeking populations anyone has ever pulled together and identified. We have developed our S2S initiative in response to their feedback. The program will continue to evolve as we learn more.</p>
<p>Finally, the ultimate goal of S2S –and the main focus of MHA—will always be to address mental health concerns before Stage 4, and move people toward effective pathways to recovery that make sense for them. </p>
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Wed, 12 Oct 2016 19:49:24 +0000EWallace1339 at http://www.nmha.orghttp://www.nmha.org/blog/s2s-our-answer-call-help#commentsCommunities in Distresshttp://www.nmha.org/blog/communities-distress
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<p><em>By Paul Gionfriddo, President and CEO</em></p>
<p>Tulsa, Milwaukee, Charlotte…</p>
<p>North Charleston, Ferguson, Baltimore…</p>
<p>Orlando, Baton Rouge, Falcon Heights…</p>
<p>These are communities forever linked by acts of violence, where in nearly every instance, a person attempting to preserve the peace of the moment lost a life.</p>
<p>These events are the sources of daily headlines, focusing on seemingly unchecked violence and unrest in America. Emotions are high, and finger pointing from all sides is ongoing. But as we try to comprehend and understand what is happening throughout the country, perhaps we need to step back and put ourselves in the shoes of the individuals living in these communities every day. Because the real story is that these are all communities in distress, and that for many of them stress and distress were ways of life long before these acts of violence moved them to the front pages of the news. </p>
<p>And if we understand that perspective, we must recognize that we have to pay careful attention in these communities and in others across the nation to the chilling effect this distress has on the mental health of the people living in them.</p>
<p>It is as if we focus on athletes kneeling during the National Anthem without seeing the reason for the protest. As the parent of mixed race kids, I’ve said it openly before. When we’re talking about stress, distress, income, discrimination, and safety, race does matter in America – and, increasingly, so does ethnicity, gender, gender identity, and a whole lot of other things that were supposed to have melted away in this great melting pot of ours.</p>
<p>So what can we do about it?</p>
<p>Each year, Mental Health America (MHA) produces a report on Mental Health in America. Our newest report, which will lay out the best, most recent unbiased information about that state of our mental health across the nation, will be out next month. It will reflect state-by-state the challenges we continue to face in making our nation healthier and stronger. And readers will see that we do indeed have a lot of challenges to overcome.</p>
<p>But what the data sources fall short of ever doing is capturing the stories behind the data – stories of the families and neighbors of people like Michael Brown, Alton Sterling, Philando Castile, Terrence Crutcher, Keith Scott, and Sylville Smith.</p>
<p>We recognize that these are stories of people living in the aftermath of trauma—from every day violence that is commonplace in some communities to the larger stories that make cable news. But for many, many more whose stories are not in the news, the experiences are the same. They come to MHA and our affiliates every day to seek help. They live with PTSD, anxiety, and depression. Their pathways to recovery will be long and often lonely ones. And they must often recover in environments of expansive hostility to them.</p>
<p>From time to time, we at MHA comment on acts of violence.</p>
<p>Most of the time, it’s to make sure that mental illnesses are not falsely associated with the causes of violence. But sometimes – like today – it is because we all need to understand the truth about distress. For many it is a fact of life. And it impacts the mental health of everyone it touches.</p>
<p>There is no doubt that we have got to take steps in this nation to prevent senseless acts of violence. But we also have to acknowledge the toll that exposure to violence has taken on us – it literally makes us physically and mentally ill.</p>
<p>At MHA, we want to help. We offer resources and <a href="http://www.mentalhealthamerica.net/mental-health-screening-tools">screening tools to monitor your mental health</a>, which thousands of people use each day. Our <a href="http://www.mentalhealthamerica.net/find-affiliate">MHA affiliates around the country</a> offer programs and services to aid communities in need. The <a href="http://disasterdistress.samhsa.gov/" target="_blank">National Disaster Distress Helpline</a>, operated by MHA – New York City, is there for everyone whenever it is needed. We also partner with others across the nation to help every community in distress find services it wants to meet its unique needs, including <a href="http://www.crisistextline.org/">Crisis Text Line</a>, that offers free text-enabled access to trained Crisis Counselors by texting MHA to 741741.</p>
<p>And we continue to promote our <em><a href="https://twitter.com/search?src=typd&amp;q=%23B4Stage4" target="_blank">#B4Stage4</a></em> campaign – to remind policy and community leaders that early identification and intervention promote recovery, and that mental illnesses are not public safety problems to be exploited, but health problems to be treated.</p>
<p>We need to work together to end the distress, the violence, and the despair that so many Americans currently experience. We can’t solve everything, but MHA wants to help. </p>
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Thu, 22 Sep 2016 14:16:14 +0000EWallace1320 at http://www.nmha.orghttp://www.nmha.org/blog/communities-distress#commentsWhy Do the Classes Stop When the Baby is Born?http://www.nmha.org/blog/why-do-classes-stop-when-baby-born
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<p><strong><em>By: Nathaniel Counts, J.D., MHA Director of Policy and Kelly Davis, MHA Policy and Programs Associate</em></strong></p>
<p>When you have your first child, you go to classes throughout your pregnancy. The classes help you feel as comfortable as you can be on the big day. But then the classes stop. You might have made it through pregnancy, but now you suddenly have a baby to take care of – and most parents would tell you that this is hardly the easiest part.</p>
<p>So why do the classes stop when the baby is born? Why don’t we equip people for one of the most important jobs they’re ever going to have to do – being a parent.</p>
<p>It’s not that parenting classes don’t exist. <a href="http://www.ajpmonline.org/article/S0749-3797(16)30184-2/fulltext">Researchers have been working for decades</a> on ways to best support parents, and several of their programs have proven highly effective. Children whose parents participate grow up doing better in school and are less likely to use substances or develop a mental health condition. Parents benefit too. They’re less likely to develop mental health problems, and many find that they end up with new friends and increased support beyond the program.</p>
<p>So while we know that parenting classes work at preventing expensive future health issues, people don’t have access to these programs because we haven’t figured out how to pay for them. Health care billing was designed for surgeries and diagnostic tests, and these kinds of ongoing preventive supports fit awkwardly into our current framework. <a href="http://archpedi.jamanetwork.com/article.aspx?articleid=1766496&amp;resultclick=1">One study in Massachusetts</a> found great results when integrating a parenting program into pediatricians’ offices, but the sites weren’t able to continue running the programs once the study was over – there was no way to for providers to be reimbursed.</p>
<p>Mental Health America (MHA) is currently exploring several avenues to reimbursement, so that parents can get access to these programs. We will outline two of the strategies toward reimbursement here.</p>
<p>The first is through the U.S. Preventive Services Task Force (USPSTF). Under the Affordable Care Act, certain public and private health care plans must cover services for which the USPSTF gives an “A” or “B” recommendation. The USPSTF has recommended <a href="http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/depression-in-adults-screening1">several behavioral health screenings</a>, along with follow-up counseling. If the USPSTF recommended parenting programs (a form of group counseling) for children, it could prevent and reduce many of the conditions they later screen for.</p>
<p>The second is through the Centers for Medicare and Medicaid Innovation (CMMI). CMMI was also created by the Affordable Care Act, and it has the unique ability to drive reforms in public health insurance by promoting services that improve outcomes and reduce costs – and parenting programs do <a href="http://www.wsipp.wa.gov/BenefitCost/Program/81">both of these</a>. Most recently, CMMI is working to increase access to the Diabetes Prevention Program (DPP), which is remarkably similar to many parenting programs. Both involve a series of group sessions to provide behavioral skills to get the best possible health outcome. If CMMI were to consider increasing access to parenting programs in the same way it did with the DPP, more providers would be able to offer them.</p>
<p>Hopefully, soon the classes won’t need to stop when the baby is born, and parents will have access to more support for the hardest job they will have to do. From our standpoint at MHA, this access brings the promise of improved mental health for both parents and children. We would love your help on this effort – please reach out to us at any time at <a href="mailto:ncounts@mentalhealthamerica.net">ncounts@mentalhealthamerica.net</a> or <a href="mailto:kdavis@mentalhealthamerica.net">kdavis@mentalhealthamerica.net</a>. </p>
<p>****<br /><em style="font-size: 12.8px; line-height: 1.6em;"><span style="font-size: 12.8px; line-height: 1.6em;">This blog post has also been published with permission from the authors on </span><a href="https://www.ffcmh.org/"><span style="font-size: 12.8px; line-height: 1.6em;">https://www.ffcmh.org</span></a></em></p>
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Thu, 15 Sep 2016 19:31:32 +0000EWallace1318 at http://www.nmha.orghttp://www.nmha.org/blog/why-do-classes-stop-when-baby-born#commentsProtecting the Rights of Everyone; Keeping Separate Firearms and Mental Health Reform http://www.nmha.org/blog/protecting-rights-everyone-keeping-separate-firearms-and-mental-health-reform
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<p><em>By: Paul Gionfriddo, Theresa Nguyen, Nathaniel Counts and Kelly Davis</em></p>
<p>Advocates have been awaiting – and many dreading – a proposed rule from the Social Security Administration (SSA) relating to firearms ownership among people with certain disabilities.</p>
<p>The rule was proposed today.</p>
<p>Mental Health America understands and acknowledges the challenge that SSA faces in implementing <a href="https://www.congress.gov/103/bills/hr1025/BILLS-103hr1025enr.pdf">the Brady Handgun Violence Prevention Act of 1993 (the Brady Act)</a>, as amended by <a href="https://www.congress.gov/110/plaws/publ180/PLAW-110publ180.pdf">the NICS Improvement Amendments Act of 2007 (NIAA)</a>, through <a href="https://www.regulations.gov/#!documentDetail;D=SSA-2016-0011-0001">the proposed rule offered today</a>. </p>
<p>The Brady Act – which is the current federal law – states:</p>
<p style="margin-left:.5in;">[I]t shall be unlawful for any licensed importer, licensed manufacturer, or licensed dealer to sell, deliver, or transfer a handgun to an individual who is not licensed under section 923, unless . . . the transferor has received . . . a statement that the transferee . . .has not been adjudicated as a mental defective or been committed to a mental institution</p>
<p>The NIAA provides additional guidance and funding for the federal and state governments to implement this law.</p>
<p>MHA appreciates the attempt made by the SSA to protect rights by notifying individuals of the SSA’s intent to report their records to the National Instant Criminal Background Check System (NICS), and providing a process for individuals to have their names removed from that list.</p>
<p>MHA has fought throughout our 107 year history to ensure that individuals with mental illness are not placed on registries. Registries threaten individual rights and create disincentives for individuals from seeking necessary treatment and services. The SSA works hard to provide benefits and supports to individuals with mental illness. MHA wants to ensure that individuals continue to use these crucial supports to further their recovery.</p>
<p>Mental illness should not be a criterion for inclusion on any list that abridges individual rights. This Administration has long been a champion for civil rights for all Americans, and for that we are deeply appreciative. To address the NIAA, MHA looks forward to working with the Administration to continue to protect the individual rights of those with mental illnesses in particular.</p>
<p>MHA is in the process of reviewing the proposed rule, and will work with affiliates and other stakeholders to submit recommendations in the coming months.</p>
<p>Given the issues that are raised and are being addressed through this proposed rule, MHA strongly urges members Congress to not take up this issue as part of its deliberations around comprehensive mental health reform this year.</p>
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Thu, 05 May 2016 16:55:06 +0000EWallace1232 at http://www.nmha.orghttp://www.nmha.org/blog/protecting-rights-everyone-keeping-separate-firearms-and-mental-health-reform#commentsMental Health America Reacts to Senate HELP Legislationhttp://www.nmha.org/blog/mental-health-america-reacts-senate-help-legislation
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<p>By: Paul Gionfriddo, MHA president and CEO</p>
<p>The Senate Health, Education, Labor, and Pensions (HELP) Committee released a draft of mental health reform legislation this week and invited comments from advocates. The committee plans to take it up on March 16.</p>
<p>The draft does not follow the structure of either S. 1945 or H.R. 2646, but takes an entirely different approach. For example, it does not include a new Assistant Secretary, relying instead on the current Assistant Secretary for Planning and Evaluation to play that role. It does not include the same new demonstration and innovation grant programs that were in the earlier proposal. It also does not include provisions related to AOT or ACT. It does include sections clarifying HIPAA and promoting Parity Law enforcement.</p>
<p>Largely because of jurisdictional issues it also does not include Medicare and Medicaid provisions, such as revisions to the IMD statute or same-day billing restrictions. <br /><br /><strong>We thank the HELP Committee for this thoughtful draft.</strong></p>
<p>In general, MHA appreciates that it pushes us forward in many areas of importance, including prevention, early identification and intervention, integration, and recovery. It does much to modernize the SAMHSA statute, and provisions such as parity enforcement and workforce planning will help millions of Americans get access to the behavioral health care that they need.</p>
<p>We have also offered ten recommendations to the Committee to make the proposal stronger.</p>
<p><strong>The recommendations are in the following areas:</strong></p>
<ul><li>
<p>Translating findings to Medicaid</p>
</li>
<li>
<p>Pay-Fors in the Bill</p>
</li>
<li>
<p>Resilience Outcomes for Population Health</p>
</li>
<li>
<p>Screening and Early Intervention</p>
</li>
<li>
<p>Integration with Schools</p>
</li>
<li>
<p>Supporting the Peer Workforce</p>
</li>
<li>
<p>Ending Incarceration of Individuals with Serious Mental Illness</p>
</li>
<li>
<p>Supporting Integration By Harmonizing Privacy Laws</p>
</li>
<li>
<p>Primary Care and Behavioral Health</p>
</li>
<li>
<p>Defunding Existing Programs</p>
</li>
</ul><p>While we have addressed them all in detail in our communication to the Committee, let me review several of the most substantive ones here.</p>
<ul><li>
<p>We presented several recommendations for translating the findings from the programs funded by the bill into the Medicaid program.</p>
</li>
<li>
<p>We recommended replacing the current statute governing 42 CFR Pt. 2, which makes it harder for individuals to get behavioral health providers to release health records to other providers, and using the $75 million that this will save to offer $15 million in funding for the following five programs:</p>
</li>
</ul><p style="margin-left: 80px;">o Peer Support Specialist Grants<br />
o Promoting Innovation Grants<br />
o Educational Integration Incentive Grants<br />
o Integration Incentive Grants<br />
o Community Mental Health Services Block Grant</p>
<ul><li>
<p>We recommended that all funds saved through enactment of early intervention strategies and through an end to incarceration of nonviolent offenders with mental illness be redirected to support programs included in the new law.</p>
</li>
<li>
<p>We recommended that the legislation result in the identification of short-term outcomes that could be used in value-based payment and population health models to predict long-term outcomes. This would create financial incentives for providers to get involved in resilience and prevention for their patient population.</p>
</li>
<li>
<p>Because the U.S. Preventive Services Task Force has recommended mental health screening for everyone over the age of eleven, including pregnant and post-partum women, we recommended adding a requirement that all entities receiving block grant dollars offer screening and early intervention to the individuals they serve – and that a significant percentage of dollars be directed to people under the age of eighteen, as is included in the House bill.</p>
</li>
<li>
<p>We recommended a few modest statutory changes – which could have a profound positive effect on the lives of our children – to promote integration of educational, special educational, and behavioral health services for children.</p>
</li>
<li>
<p>We recommended a more comprehensive approach to promoting the work of peers and the development of the peer workforce.</p>
</li>
<li>
<p>We recommended that the legislation include the language in the House bill for the Interagency Coordinating Council to create a plan to end incarceration of individuals with serious mental illness or serious emotional disturbance for non-violent offenses within 10 years.</p>
</li>
<li>
<p>We recommended an idea promoted by Senator Franken to improve pre-service training for all provider types in behavioral health.</p>
</li>
<li>
<p>We expressed concerned about Sec. 409, which repeals a number of existing programs. We have not had time to review all of these in detail, but hope that these are simply programs that are no longer funded and not programs that are being defunded. </p>
</li>
</ul><p>Our bottom line is this. The proposal is another good start, and further evidence of a bipartisan commitment to mental health reform during this session of Congress. That’s great, and we’re grateful. But there is still much work to be done. Members of the House and Senate need to work together to make this happen. And we’re not from the government, and are here to help!</p>
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Thu, 10 Mar 2016 19:06:05 +0000EWallace1139 at http://www.nmha.orghttp://www.nmha.org/blog/mental-health-america-reacts-senate-help-legislation#commentsA Mother's Reckoning: A Tragic Story That Builds the Case for Early Interventionhttp://www.nmha.org/blog/mothers-reckoning-tragic-story-builds-case-early-intervention
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<p><em><strong>By: Paul Gionfiddo, president and CEO, Mental Health America</strong></em></p>
<p>We don’t usually use this blog to review books. <a href="http://amothersreckoning.com/"><em>A Mother’s Reckoning</em></a> was for me — as it will be for many people — a difficult book to read. It speaks to an incredibly raw and relevant topic.</p>
<p><em>A Mother’s Reckoning</em> was written by Sue Klebold. Sue’s son Dylan died by suicide in 1999, and she writes of her pain in his passing.</p>
<p>But Sue’s pain is different and more intense than most. This is because before he died by suicide, Dylan and his friend Eric Harris massacred twelve students and one teacher at Columbine High School, injured twenty-four others, and changed our world.</p>
<p><strong>It may be hard to believe that many parents will relate to her story. </strong></p>
<p>Like Sue in the days leading up to the horrible tragedy, even when faced with clear indications that a child is beginning to struggle, they have no understanding of how to process that information, no language to use to describe it, and no place to turn for support, and no idea what to do next. </p>
<p>Sue makes no excuses, but she acknowledges that she did not know the warning signs or clues that pointed to Dylan's depression. Even if she had, she would not have seen them in Dylan. Up until the day he died, she believed her son was typical, she knew him well, and her relationship with him was open and honest.</p>
<p>Dylan successfully hid his depression from her. He also hid much of his life from her. He hid his plans for the massacre and the toxicity of his relationship with Eric.</p>
<p><strong>The consequences of Dylan’s secrecy were tragic for an entire nation. </strong></p>
<p>But every day, there are smaller tragedies that parents face when their children are not mentally healthy. These tragedies are captured not in the headlines, but in the young people who are homeless in our streets, those who languish in our jails, or those whose deaths are noticed only in the slight and steady uptick in the nation’s suicide rate. And then there are those who <em>survive </em>violence like that at Columbine or Newtown — children and adults who for years to come may face a multitude of physical and mental health challenges. Long after the headlines fade and the reporters go home, they still need our help.</p>
<p>In our <a href="http://www.mentalhealthamerica.net/www.mhascreening.org">MHA screening program</a>, one-third of screeners are between the ages of 11 and 17 - because perhaps they don't have access to depression, anxiety, and other screening tools elsewhere. Like all age groups, two-thirds screen as positive for the condition for which they screen. Two-thirds of those tell us they have never been diagnosed or treated for the problem or condition. And a third say they plan to do nothing after getting their results.</p>
<p>The truth is that most depression will not result in death, and most bad relationships will do no lasting harm. But Dylan’s depression did progress to Stage 4, and the harm that resulted takes one’s breath away.</p>
<p><strong>So how can we prevent this? </strong></p>
<p>I’m not saying we could have prevented the tragedy at Columbine. But we can and should identify mental health concerns early. We should intervene aggressively to mitigate and address them. And we should never forget how many lives were taken and ruined in Columbine and elsewhere because as a matter of public policy we do not do these things.</p>
<p>There are people who believe that today’s status quo is acceptable. They are afraid that if we change it, it will certainly make things worse. I think they are wrong about this. Yes, some people will point to the unspeakable harm caused by Dylan and argue that this is why we need to reform our mental health system. They will see only the connection between his mental illness and the violence he perpetrated.</p>
<p>But if we really listen to the message of <em>A Mother’s Reckoning</em>, I think we’ll come to a different conclusion. </p>
<p><strong>B4Stage4 means more…</strong></p>
<p>Acting Before Stage 4 means more than acting after a crisis has occurred, more than trying to pick up the pieces of broken lives, more than wishing we could go back and change one tragic day.</p>
<p>Acting Before Stage 4 means bringing mental health concerns into the light of day, treating not just “serious” mental illnesses but treating all mental illnesses seriously, and making health and recovery our daily goals.</p>
<p>This is the essence of MHA's B4Stage4 program and philosophy – a program Sue Klebold supports.</p>
<p>If we listen to her voice and try to learn from what she has experienced, our pathways to mental health may be clearer. We will hopefully be less quick to judge, but quicker to act – in response to depression, to the suicidal thinking that can accompany it, and to the rage we sometimes don’t see in young people when we are distracted by the many other challenges in our lives.</p>
<p>We will understand that we are all part of the bigger story, and that we must all do what we can to help all of our children, including those who need our help the most.</p>
<p> </p>
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Tue, 16 Feb 2016 12:47:40 +0000EWallace1120 at http://www.nmha.orghttp://www.nmha.org/blog/mothers-reckoning-tragic-story-builds-case-early-intervention#commentsChanges to HIPAA Privacy Rule May Help Distinguish Mental Illness from Violencehttp://www.nmha.org/blog/changes-hipaa-privacy-rule-may-help-distinguish-mental-illness-violence
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<p><em>By: Paul Gionfriddo, President and CEO</em></p>
<p>This week, the President announced a number of initiatives aimed at reducing violence in America. Two of them specifically touched on mental health/mental illness. The first was an announcement that the Administration was proposing the expenditure of $500 million for mental health services. There were no details about how those dollars might be spent and so we will address that later. The second was an announcement about changes to HIPAA that would permit HIPAA-covered entities to report information to the FBI firearms registry database. </p>
<p>The Administration’s changes to the HIPAA privacy rule reflect an effort to balance a number of competing interests – those who favor gun control, those who want to protect second amendment rights, those who provide diagnostic and treatment services to people with mental health concerns, and people who have mental illnesses.</p>
<p>It makes no changes to the HIPAA law or Brady Act, but it clarifies and limits the information that can be reported to the FBI’s National Instant Criminal Background Check System (NICS).</p>
<p>Since 1993, when the Brady Act was passed, (and really since 1968 when the Gun Control Act was passed) it has been illegal for the following to own or possess firearms: “individuals who have been involuntarily committed to a mental institution; found incompetent to stand trial or not guilty by reason of insanity; or otherwise have been determined by a court, board, commission, or other lawful authority to be a danger to themselves or others or to lack the mental capacity to contract or manage their own affairs, as a result of marked subnormal intelligence or mental illness, incompetency, condition, or disease.” (45 CFR Part 164, 1/4/16)</p>
<p>The NICS was intended to include the names of all of those individuals who could not possess firearms legally. This presents no problem for judicial system reporters. They add the information to their state repository, which in turn is supposed to report it to the NICS. </p>
<p>However, in some states, the repository is housed in a HIPAA “covered entity,” – a provider covered by the HIPAA law. And in some cases, a HIPAA-covered entity – not a court – makes the determination as to whether an individual meets the standard for inclusion in the registry and orders an involuntary commitment.</p>
<p>While HIPAA allows for the sharing of an individual’s protected health information (PHI) without the individual’s authorization for law enforcement purposes, it was not clear to these covered entities that they could report the names for inclusion in the NICS database without violating a patient’s privacy.</p>
<p>Therefore, what the rule says is this: (1) a firearms control data center housed in a HIPAA-covered entity can share limited demographic information with the national registry; and (2) a HIPAA-covered entity that is participating in a judicial proceeding to determine that a person cannot lawfully have a firearm (such as ordering an involuntary commitment) can share limited demographic information with the registry.</p>
<p>The new provision does not:</p>
<ul><li>Allow for the addition sharing without authorization of diagnosis or treatment information of any kind, even for people who cannot legally possess firearms;</li>
<li>Affect anyone who voluntarily seeks mental health services of any kind; i.e., even if they say they have an intent to harm themselves or others a provider cannot simply add their name to the registry – they must go through the judicial process and be found to meet one of the categories in the existing law;</li>
<li>Allow for the additional sharing of information between or among covered entities or their business associates without authorization;</li>
<li>Have any effect on HIPAA-covered entities that do not house the data repositories or make determinations regarding involuntary treatment or legal competency;</li>
<li>Add anyone new to the list of people who are not legally able to possess firearms.</li>
</ul><p>This change will affect a relatively small number of people (maybe in the hundreds, maybe in the thousands). So why does it matter?</p>
<p>It has already been determined that it is illegal for the individuals whose names will be added to the list to own or possess firearms. So this might prevent a tragic event without infringing on the rights of anyone who can possess firearms.</p>
<p>More importantly from the perspective of those of us who advocate daily on behalf of individuals with mental health conditions, this might also help to draw a greater distinction in the minds of the public between those who have mental illnesses and those who are violent. The following diagram will help to explain why:</p>
<p style="text-align: center;"><img alt="" src="http://www.mentalhealthamerica.net/sites/default/files/VenGraphic.png" style="width: 500px; height: 353px;" /></p>
<p>People with violent tendencies and even people with serious mental illnesses are two distinctly different groups of people. In some instances, they overlap, but most often they do not. Those who think that a diagnosis of mental illness should be a reason to deny firearms possession are off-track.</p>
<p>Millions of people have mental illnesses and not a violent thought or idea. Millions of other people have violent thoughts and not a mental illness. </p>
<p>The HIPAA change implicitly acknowledges this, and this is very important to those of us who are advocates.</p>
<p>It is our hope that people who embrace the change will do so not only for its carefully crafted limitations on the sharing of additional information and because it will add to the national registry some more people for whom it is already illegal to possess firearms, but also because its helps to clarify the distinctions we must continually make between those who have mental illnesses and those who have violent tendencies. </p>
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Tue, 05 Jan 2016 21:30:27 +0000EWallace1100 at http://www.nmha.orghttp://www.nmha.org/blog/changes-hipaa-privacy-rule-may-help-distinguish-mental-illness-violence#comments